People’s Pharmacy: Shots may lower bone density

Q. What effect do cortisone shots have on the body? In order to keep playing tennis, I have received shots in my hip, knees and shoulders during the past few years.

I have read that oral prednisone can lead to osteoporosis. What about shots? Are there any strategies to reverse such a problem?

A. Diminished bone density and osteoporosis are well-known complications of oral prednisone treatment. A new study of injected corticosteroids found that a single shot into the spine for back pain reduced bone mineral density of the hip (Spine, Dec. 1, 2012). Whether administered by injection, in pills or through an inhaler, steroids weaken bones.

We are sending you our Guide to Osteoporosis, with a discussion of drugs that hasten bone loss and ways to prevent it. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (65 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. U-92, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

Q. Now that I’m nearing divorce court (in large part due to sexual difficulties), I was dismayed by the response to a person inquiring about finasteride (Proscar). I have every single side effect in your answer.

I have not taken Proscar for some time. I was very distressed to read that the sexual side effects may last for years.

I have zero libido and zero erections. How long might these effects last? Can they be reversed with over-the-counter treatments, or am I history, sexually? I am only 60.

A. No one knows how long sexual side effects such as lowered libido, erectile problems, reduced penis size and diminished sensation or pleasure during orgasm may last after finasteride is stopped.

This finding is relatively recent (Journal of Sexual Medicine, November 2012). The men in this study were followed for up to 16 months after they stopped the drug, and many were still having problems.

Finasteride is used to treat male pattern baldness and symptoms of enlarged prostate. As far as we know, there is no OTC treatment to reverse the sexual side effects. Please discuss your symptoms with a urologist to see if there are any other treatment options.

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Q. When the recall of Ranbaxy atorvastatin was announced because of glass particles in the pills, I had 30 left of a 90-day supply. The pharmacist said he had no way of tracing the lot number of my prescription. He offered to replace the pills I still had with pills from another supplier of atorvastatin.

I don’t understand how manufacturers can track lot numbers of canned goods or cereal, yet consumers have no way of knowing if they have taken pills from recalled lot numbers. Apparently, pharmacies are not required to pass the lot number on to the user or record it in their computer system.

A. You have identified a weak link in the prescription drug supply chain. Many states do not require pharmacists to note the lot number on dispensed medication or even keep a record of the original source. If there is a recall, as there was in the case of Ranbaxy’s atorvastatin, there is no good way to determine whether dispensed pills are problematic.